You’ll likely have seen the news that GSK is partnering with Verily (a Google startup) to launch a company called Galvani. This will investigate devices that directly modify nerve transmission, which is something that I don’t think any large drug company has ever put money into – certainly not the $700 million that GSK has announced. But it’s not like they’d ever spend $700 million on something that’s not going to work out – oh, OK. But let’s try to assess this deal on its own merits.
First off, I have to give the company credit for trying something new and being willing to put money behind it. But then again, Sirtris (the earlier $700 million dollar investment referred to) was pretty new stuff, too, and doesn’t seem to have worked out in the slightest. Admittedly, that can well happen to these sorts of ideas, but there are a lot of current (and former) GSK people who claim that the company didn’t perform very compelling due diligence on that other deal, and ignored people who did, which will certainly lengthen the odds for you even more. So what about “bioelectronic medicine”, as they’re calling this new field?
I’ll freely confess that it’s mostly out of my expertise – but it’s out of most people’s expertise. GSK has been putting money into the field for three years or so, and they say that they have a list of candidate nerves that directly affect tissues involved with disease, and whose signals they’re planning on either enhancing or blocking. I can certainly how that could work, but I can certainly see how it could not work, too (and there are plenty of disease processes that are not necessarily driven by nerve impulses). The company says that they’re going after diabetes first, so what’s the target?
If I had to guess, I’d say that they’re thinking about slowing or stopping the inappropriate gluconeogenesis in the liver of Type II diabetes patients. Directly trying to stimulate insulin secretion looks like a losing game in comparison – the peripheral tissues are already resistant to insulin in Type II, and the islet cells are already under strain trying to produce enough of it into the blood to get a response. But in the disease state, the liver is (insanely, from our outside perspective) busy making even more new glucose and dumping it into the bloodstream. As I understand it, that may be partly because the elevated free fatty acids in the bloodstream make the hepatic tissue act as if it’s working under fasting/starving starving conditions, which is when it needs to produce glucose for the brain, but I think there’s still a lot that’s unknown about the process.
Here’s an interview at Stat with Moncef Slaoui of GSK about the whole deal. And here’s his answer when Ed Silverman asks him where the whole thing came from:
Well, I became head of R&D (at Glaxo) in 2006 and my mission was to turn around the productivity, which was lagging. And I undertook a deep reorganization and by 2011, we had the early signs that we made a significant turnaround and productivity would go up. But in 2011, early 2012, we realized it took five to six years to turn around R&D asked ourselves whether it will wane away and if the way we discover drugs will it be sustainable in long run. … You know, the way we ensure a drug works is that it has a unique structure to interact with a specific target.
As I recall it, GSK spent the early 2000s telling everyone that productivity was going Great! Just Fine! To be fair, that’s what everyone in the business tends to say most of the time – you only hear that there were problems in retrospect, generally after someone new comes in to clean up all the stuff that was going Just Fine. That “deep reorganization” would be this stuff, more here, and those posts will provide you with another look at the way history gets rewritten a bit during these things.
But now let’s ask ourselves what Slaoui means when he says “we realized it took five to six years to turn around R&D (and) asked ourselves whether it will wane away”. He may be talking about the company’s moves out of oncology and some other areas, and into (so it’s seemed) more high-volume low-margin parts of the business. (As for that “wane away” phrase, there are a lot of ex-GSK people who would be glad to point out that things do indeed wane away pretty quickly when you close down whole research sites!)
Still, I will definitely congratulate the company for having the uh, nerve, to move into nerve transmission as a therapeutic mode. If they can get this to work, they’ll have staked out a huge first-mover position in the field. Now it just has to work, and that brings up the partnership with Verily. As the folks at Stat have been detailing, Verily itself has not been without problems. The optimistic take is that they’re just the sort of people to take on an out-there project like this one, but the pessimistic take is that an out-there project like this one is just the sort of thing that they might convince someone else that they’re terrific at, even if they aren’t. So far, it appears that none of the biggest, most noisy Verily projects actually seem to be going well, if that last link is accurate, so there’s room to wonder about this one.
But then again, GSK has been working on some of this stuff themselves for the last three years, and they presumably have some internal data that they find convincing. This will be a very interesting area to watch, that’s for sure. Slaoui says that “And in the next 18 months, we plan to start clinical trials with a prototype device to establish clinical proof of concept“, so there’s a marker down. Let’s see what happens.